I agree about steps. Nothing helpful about monitoring that. I wear a Fitbit Inspire 3. I find its tracking of sleep, resting heart rate, calories burned, and time that I'm in appropriately elevated heart rate zones (adjusted for taking a beta blocker) very useful. I don't have rigid daily goals but it's a good way for me to keep track of trends. For example, I am working at exercising more and I can easily check trends over time. It counts activities like cleaning my pool (which doesn't generate a lot of steps but can elevate heart rate nicely when brushing and vacuuming). I also track diet with MyFitnessPal and weight (and associated stats like body fat %) with a digital scale. I prepare updates for my cardiologist and she finds them useful.
Well said! I was very motivated by the step count on my smart watch at first, but over time became less so , for reasons similar to those you have detailed. However, there are many other metrics measured by smart watches, some with unclear value, and unknown reliabilty. As a relatively old (64!) and experienced physician, I will admit to not having a great deal of knowledge about the significance of heart rate variability. When I recently experienced an unusually severe bout of a type of nonspecific pain that I am familiar with from many past occasions, I was very alarmed to see a major drop in my HRV over the days that I was symptomatic, paired with a 10 beat increase in my resting heart rate. Recognising my own lack of knowledge about the significance of this, I realised that very few of the colleagues that I might consult with would know much more about it either. I was able to learn, with some research, that virtually any acute stress, including acute pain, can lower HRV, and that it is not a specific marker of cardiac issues. Clearly my pain and stress increased my sympathetic response, which explains these changes to me. However, considering how alarmed I first felt on seeing these measures, I can only imagine how much more alarming it might feel for someone who could not as readily find and understand that information. I am sure that you, Jim, like myself, and many of our colleagues, have been, and will increasingly be approached by patients with questions and concerns about metrics they see on their wearable devices and don't understand. It behooves all of us to learn about these, so that we can properly advise (and, at least some of the time, reassure) our patients about their significance, but there remain many unanswered questions about the reliability of the measures and their translation to clinically informative data. And for metrics where we do not yet fully understand the significance, I wonder if measuring them for people is helping or harming them?
I went down the rabbit hole after a medical emergency caused by a surgery. I was and am healthy. Have taught exercise classes for almost 50 years. But all of the sudden, because of the anxiety caused by that,I had to track not only steps, which was the only thing I’d done in the past, but now obsessed over all the other stats too. Read your article this AM and promptly put my Fitbit air band in the drawer for the day. Took a walk. Not obsessing on steps or stats today and feel better. Thank you.
Oh I have let my tracker get the best of me too. I hated not getting the credit when I didn’t have my tracker on me! I got a little obsessed with the contests Fitbit ran and yes, I would march in place if I didn’t make my stated goal for the day. My relationship is healthier now. I do what I can as I’m dealing with arthritis but I no longer obsess over it.
Agree the other problem is most of all the high end Whoop / Qura / Apple / Hume are not accurate , as someone who vigorous weight trains (HIRT ) or finishers at end of training as well as 40 min swims yet 1/3 rd of time either do not record or only half
The 10,000 step goal really helped me to stay honest. I don’t always reach that goal nor am I obsessed with it, but I need goals for exercising. I guess I’m a little lazy 😉
Thank you for writing this! I couldn’t agree more. I am sick of the step counting fanatics. I don’t walk/run much — I blame my busted knee and toe joints and various wearables would insult me for it (Garmin is famous for it). I much prefer rowing and indoor cycling.
terrific points, terrific post, Dr. Stein. thank you.
I agree about steps. Nothing helpful about monitoring that. I wear a Fitbit Inspire 3. I find its tracking of sleep, resting heart rate, calories burned, and time that I'm in appropriately elevated heart rate zones (adjusted for taking a beta blocker) very useful. I don't have rigid daily goals but it's a good way for me to keep track of trends. For example, I am working at exercising more and I can easily check trends over time. It counts activities like cleaning my pool (which doesn't generate a lot of steps but can elevate heart rate nicely when brushing and vacuuming). I also track diet with MyFitnessPal and weight (and associated stats like body fat %) with a digital scale. I prepare updates for my cardiologist and she finds them useful.
To each their own.
Well said! I was very motivated by the step count on my smart watch at first, but over time became less so , for reasons similar to those you have detailed. However, there are many other metrics measured by smart watches, some with unclear value, and unknown reliabilty. As a relatively old (64!) and experienced physician, I will admit to not having a great deal of knowledge about the significance of heart rate variability. When I recently experienced an unusually severe bout of a type of nonspecific pain that I am familiar with from many past occasions, I was very alarmed to see a major drop in my HRV over the days that I was symptomatic, paired with a 10 beat increase in my resting heart rate. Recognising my own lack of knowledge about the significance of this, I realised that very few of the colleagues that I might consult with would know much more about it either. I was able to learn, with some research, that virtually any acute stress, including acute pain, can lower HRV, and that it is not a specific marker of cardiac issues. Clearly my pain and stress increased my sympathetic response, which explains these changes to me. However, considering how alarmed I first felt on seeing these measures, I can only imagine how much more alarming it might feel for someone who could not as readily find and understand that information. I am sure that you, Jim, like myself, and many of our colleagues, have been, and will increasingly be approached by patients with questions and concerns about metrics they see on their wearable devices and don't understand. It behooves all of us to learn about these, so that we can properly advise (and, at least some of the time, reassure) our patients about their significance, but there remain many unanswered questions about the reliability of the measures and their translation to clinically informative data. And for metrics where we do not yet fully understand the significance, I wonder if measuring them for people is helping or harming them?
Thanks, Tova! You find this piece useful: https://substack.com/@jamesstein18/note/c-276822638?r=p5sxn&utm_medium=ios&utm_source=notes-share-action
I went down the rabbit hole after a medical emergency caused by a surgery. I was and am healthy. Have taught exercise classes for almost 50 years. But all of the sudden, because of the anxiety caused by that,I had to track not only steps, which was the only thing I’d done in the past, but now obsessed over all the other stats too. Read your article this AM and promptly put my Fitbit air band in the drawer for the day. Took a walk. Not obsessing on steps or stats today and feel better. Thank you.
Oh I have let my tracker get the best of me too. I hated not getting the credit when I didn’t have my tracker on me! I got a little obsessed with the contests Fitbit ran and yes, I would march in place if I didn’t make my stated goal for the day. My relationship is healthier now. I do what I can as I’m dealing with arthritis but I no longer obsess over it.
Agree the other problem is most of all the high end Whoop / Qura / Apple / Hume are not accurate , as someone who vigorous weight trains (HIRT ) or finishers at end of training as well as 40 min swims yet 1/3 rd of time either do not record or only half
They cause more anxiety then benefits
Thanks! You might find this useful too: https://substack.com/@jamesstein18/note/c-276822638?r=p5sxn&utm_medium=ios&utm_source=notes-share-action
Great and original column. I’ve never seen these issues addressed so effectively.
The 10,000 step goal really helped me to stay honest. I don’t always reach that goal nor am I obsessed with it, but I need goals for exercising. I guess I’m a little lazy 😉
Thanks for commenting. I am glad it has been helpful for you!
Thanks Jim. I enjoy and learn a lot from you!
Thank you!
Excellent review, Jim. Thank you.
Peter Drucker wrote, "What gets measured gets managed."
(Sometimes alternatively phrased as: "If you can't measure it, you can't improve it.")
Thank you for writing this! I couldn’t agree more. I am sick of the step counting fanatics. I don’t walk/run much — I blame my busted knee and toe joints and various wearables would insult me for it (Garmin is famous for it). I much prefer rowing and indoor cycling.